Psych aspects of CV disease

Question 1

Betablockers and depression

Answer 1

more concern with lipophilic durgs (Carvedilol, metoprolol, propranolol)
not really proved

Other neuropsychological sE: drowsiness, fatigue, lethargy, sleep disorder

Question 2

Antihypertensives- lithiumq

Answer 2

thiazide diuretics increase lithium levels, due to distal tubal
lithium increases 20-40%

Loop diuretics and ACE have a varied risk of lithium toxicity

Question 3

Antihypertensives - Antidepressants

Answer 3

Beta blockers and SSRIs (paroxetine inhibits 2D6 same metabolism of metoprolol) increase in plasmaconcentration

Clonidine and mirtazapine

Question 4

Cardiovascular disease and depression

Answer 4

depression is a risk factor CVD
CVD causes depression via (chronic disease burden, lifestyle restrictions and treatment intensity, INflammatory mechanism)

Depression causes CVD: adherence, physical inactivity, smoking, physiologic factors (cardiac dysregulation/autonomic dysfunction, inflammation, endothelial dysfunction, platelet dysfunction

Question 5

CVD and depressed

Answer 5

SSRI!, SNRIs (adrenergic effect adversely impact CHD)

TCA have type 1A antiarrhythmic properties (avoid floowing MI
could prolong QT interval–> TdP

Question 6

CVD and anxiety

Answer 6

higher in CVD disease than in normal pop

Treatments: SSRI,CBT (cognitive behavioral therapy)

Question 7

Takotsubo Cardiomyopathy

Answer 7

In the absence of significant coronary artery disease
Triggered by emothional or physical stress

Sudden Chest pain or SOB, ECG looks like MI, no obstruction, Octopus pots on ECG, complete resolution of LV after event a few weeks

Common in women (2% of suspected ACS), triggers (death finance, natural disaster, illness)

Catecholamine excess: NE levels are elevated in 75% in some studies, plasma catecholamines are significantly higher than in cases of MI,